Background: The medical culture is defined by mental illness stigma, non-disclosure, and avoidance of professional treatment. Little research has explored attitudes and help-seeking behaviors of psychiatry trainees if they were to become mentally ill.Method: Psychiatry residents (n = 106) from training centres across Ontario, Canada completed a postal survey on their attitudes, barriers to disclosure, and help-seeking preferences in the context of hypothetically becoming mentally ill.Results: Thirty-three percent of respondents reported personal history of mental illness and the frequency of mental illness by year of training did not significantly differ. The most popular first contact for disclosure of mental illness was family and friends (n = 61, 57.5%). Frequent barriers to disclosure included career implications (n = 39, 36.8%), stigma (n = 11, 10.4%), and professional standing (n = 15, 14.2%). Personal history of mental illness was the only factor associated with in-patient treatment choice, with those with history opting for more formal advice versus informal advice.Conclusions: At the level of residency training, psychiatrists are reporting barriers to disclosure and help-seeking if they were to experience mental illness. A majority of psychiatry residents would only disclose to informal supports. Those with a history of mental illness would prefer formal treatment services over informal services.
Aims and methodMephedrone is a cathinone with amphetamine-like stimulant effects, and is a commonly used recreational drug. The adverse effects of mephedrone use have not been extensively studied. All individuals who self-presented between January and June 2010 to the emergency departments and acute mental health services in Edinburgh and Falkirk with adverse effects of self-reported mephedrone use were identified.ResultsTwenty cases were identified and analysed. Severe agitation was the most common presenting problem (70%), with 40% of individuals developing psychotic symptoms and a further 20% reporting low mood and suicidality. One person died by suicide.Clinical implicationsMephedrone can produce amphetamine-like adverse psychological intoxication effects, particularly in those with a history of mental illness. Clinicians should consider advising patients on the adverse effects of mephedrone, where relevant.
Résumé Background: Opioid use disorder (OUD) is a potentially chronic, relapsing condition associated with a great degree of morbidity and mortality. In Canada, OUD is at the forefront of the opioid epidemic, which has claimed more than 8000 lives between January 2016 and March 2018. As individuals with OUD are more likely to receive health services from the emergency department and acute hospitalizations, it makes logical sense for there to be a move toward improving the quality of hospital-based services. Hospitalization represents a golden opportunity to connect patients who have OUD with evidence-based treatments. Objectives: To evaluate the effectiveness and offering of hospital-based interventions for individuals with OUD by way of a scoping review. Data sources: Five online databases were searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Study selection: Randomized and nonrandomized intervention studies were considered eligible for inclusion in this scoping review. Results: Twenty two of 354 retrieved papers met inclusion criteria. Detoxification programs (n = 7), relapse prevention programs (n = 11), maternal–perinatal programs (n = 2), and combination programs (n = 2) were identified. Both interventions and outcome measures varied widely between studies, but the overall findings demonstrated the effectiveness of the interventions considered with regard to improved retention in treatment, reduction of illicit opioid use, and reduced hospital length of stay. Conclusions: The findings of our study demonstrate that there is a high degree of congruence between the effectiveness of interventions initiated in the community versus hospital-based treatments for individuals with OUD. Hospitalization represents a golden opportunity to connect patients who have OUD with evidence-based treatments. Contexte: Les troubles liés à l’usage d’opioïdes (TLUO) sont une affection potentiellement chronique et récurrente associée à un degré élevé de morbidité et de mortalité. Au Canada, TLUO figure au premier rang dans l’épidémie d’opioïdes. Elle a coÛté la vie à plus de 8 000 personnes entre janvier 2016 et mars 2018. Comme les personnes ayant cette maladie sont plus susceptibles de recevoir des soins du service des urgences et des hospitalisations en soins de courte durée, il est logique de progresser vers l’amélioration de la qualité des services hospitaliers. L’hospitalisation représente une occasion en or de mettre en relation les patients présentant une TLUO avec des traitements éprouvés. Objectifs: évaluer l’efficacité et l’offre d’interventions en milieu hospitalier pour les personnes atteintes de TLUO par le biais d’une étude de la portée des incidences. Sources de données: cinq bases de données en ligne ont été explorées conformément aux directives de PRISMA. Sélection de l’étude: les études d’intervention aléatoires et non aléatoires ont été considérées comme admissible à l’inscription dans cet examen exploratoire. Résultats: 22 des 354 études récupérés répondaient aux critères d’inclusion. Des programmes de désintoxication (n = 7), des programmes de prévention des rechutes (n = 11), des programmes maternels-périnataux (n = 2) et des programmes combinés (n = 2) ont été identifiés. Les interventions et les mesures de résultats variaient beaucoup d’une étude à l’autre, mais l’ensemble des résultats démontrait l’efficacité des interventions envisagées en ce qui concerne l’amélioration de la rétention du traitement, la réduction de la consommation d’opioïdes illicites et la réduction de la durée de séjour en hôpital. Conclusions: Les résultats de notre étude démontrent qu’il existe un degré élevé de congruence entre l’efficacité des interventions initiées dans la communauté et les traitements en milieu hospitalier pour les personnes atteintes de TLUO. L’hospitalisation représente une occasion en or de mettre en relation les patients présentant un TLUO avec des traitements éprouvés.
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